II 

118TH CONGRESS 

2D SESSION S. 3892 

To amend titles XVIII and XIX of the Social Security Act to increase 

access to community health workers under the Medicare and Medicaid 

programs. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2024 

Mr. CASEY introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to increase access to community health workers under 

the Medicare and Medicaid programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Community Health 

5 Worker Access Act’’. 

6 SEC. 2. COVERAGE OF COMMUNITY HEALTH SERVICES 

7 UNDER PART B OF THE MEDICARE PROGRAM. 

8 (a) COVERAGE OF SERVICES.— 


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1 (1) IN GENERAL.—Section 1861(s)(2) of the 

2 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

3 amended— 

4 (A) in subparagraph (II), by striking ‘‘sub5 section (lll)(3))’’ and all that follows and insert6 ing ‘‘subsection (lll)(3));’’; 

7 (B) in subparagraph (JJ), by inserting 

8 ‘‘and’’ after the semicolon at the end; and 

9 (C) by adding at the end the following new 

10 subparagraph: 

11 ‘‘(KK) community health services (as defined in 

12 subsection (nnn)(1)) furnished on or after January 

13 1, 2025;’’. 

14 (2) DEFINITIONS.—Section 1861 of the Social 

15 Security Act (42 U.S.C. 1395x) is amended by add16 ing at the end the following new subsection: 

17 ‘‘(nnn) COMMUNITY HEALTH SERVICES; COMMUNITY

18 HEALTH AGENCY.— 

19 ‘‘(1) COMMUNITY HEALTH SERVICES.— 

20 ‘‘(A) IN GENERAL.—The term ‘community 

21 health services’ means the services described in 

22 subparagraph (B) that are furnished— 

23 ‘‘(i) by a community health agency (as 

24 defined in paragraph (2)); and 


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1 ‘‘(ii) in accordance with an individual 

2 needs assessment that meets requirements 

3 established by the Secretary and is con4 ducted under the supervision of an applica5 ble provider; and 

6 ‘‘(B) SERVICES DESCRIBED.—The services 

7 described in this subparagraph are the fol8 lowing: 

9 ‘‘(i) PREVENTIVE SERVICES.—Diag10 nostic, screening, and preventive services 

11 to prevent illness, disease, injury, or any 

12 other physical or mental health condition, 

13 reduce physical or mental disability, and 

14 restore an individual to the best possible 

15 functional level, including the following: 

16 ‘‘(I) Services described in section 

17 1905(a)(13). 

18 ‘‘(II) Containment of infectious 

19 disease outbreaks, including providing 

20 in-language, culturally specific, and 

21 trusted support services, such as pub22 lic health outreach. 

23 ‘‘(III) Direct provision of 

24 screenings and basic health services, 


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1 as recommended by an applicable pro2 vider. 

3 ‘‘(IV) Provision of coaching and 

4 social support, such as support for in5 dividuals to obtain health care, sup6 port to reduce stress and social isola7 tion, support for self-management of 

8 disease, and other support necessary 

9 for the prevention and management of 

10 health conditions. 

11 ‘‘(V) Care coordination and con12 nection to preventive care services, in13 cluding for chronic conditions, such as 

14 diabetes, asthma, chronic obstructive 

15 pulmonary disease, congestive heart 

16 disease, autoimmune disease, or be17 havioral health conditions. 

18 ‘‘(VI) Facilitation of transpor19 tation to needed services. 

20 ‘‘(VII) Promotion of healthy be21 haviors, such as physical activity and 

22 smoking cessation. 

23 ‘‘(VIII) Case management and 

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1 nology, home modifications, and other 

2 adaptations to increase their ability to 

3 live independently in the community. 

4 ‘‘(IX) Provision of support for 

5 health literacy and cross-cultural com6 munication. 

7 ‘‘(X) Provision of culturally and 

8 linguistically appropriate health edu9 cation. 

10 ‘‘(XI) Other services, as the Sec11 retary determines appropriate to pre12 serve and improve individual and pub13 lic health. 

14 ‘‘(ii) SERVICES TO ADDRESS SOCIAL

15 DETERMINANTS OF HEALTH.—Services to 

16 address social determinants of health, in17 cluding the following: 

18 ‘‘(I) Assessment of individual and 

19 community needs and communicating 

20 identified needs to public health, 

21 health care, and social service agen22 cies. 

23 ‘‘(II) Provision of outreach and 

24 education regarding health insurance, 


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1 and other health and social service 

2 systems. 

3 ‘‘(III) Provision of education, as4 sessment of needs, and social support 

5 through home visiting. 

6 ‘‘(IV) Provision of case manage7 ment (as defined in section 

8 1915(g)(2)) and linkage to resources 

9 to alleviate financial strain, including 

10 food, housing, child services, tech11 nology, educational services, employ12 ment services, and other services. 

13 ‘‘(V) Identification of under14 served populations and referring them 

15 to appropriate health care agencies 

16 and community-based programs and 

17 organizations in order to increase ac18 cess to quality health and social serv19 ices and to streamline care, including 

20 serving as a liaison between individ21 uals and communities and health and 

22 social service organizations. 

23 ‘‘(C) APPLICABLE PROVIDER.—For pur24 poses of subparagraphs (A)(ii) and (B)(i)(III), 

25 the term ‘applicable provider’ means— 


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1 ‘‘(i) a physician (as defined in section 

2 1861(r)); 

3 ‘‘(ii) a physician assistant, a nurse 

4 practitioner; and a clinical nurse specialist 

5 (as such terms are defined in section 

6 1861(aa)(5)); and 

7 ‘‘(iii) any other practitioner described 

8 in section 1842(b)(18)(C) that the Sec9 retary determines appropriate. 

10 ‘‘(2) COMMUNITY HEALTH AGENCY.—The term 

11 ‘community health agency’ means an entity, includ12 ing a community-based organization, a nonprofit or13 ganization, an urban Indian organization, a commu14 nity health worker network, a Federally qualified 

15 health center, a rural health clinic, a local or State 

16 public health department, an academic institution, a 

17 health care provider, and any other organization 

18 deemed appropriate by the Secretary, that meets re19 quirements established by the Secretary, which may 

20 include the following requirements: 

21 ‘‘(A) The entity provides for the employ22 ment of health workers who share lived experi23 ences with the community served and minimize 

24 barriers to employment, including formal edu25 cational requirements. 


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1 ‘‘(B) The entity provides for market wage 

2 compensation and professional development and 

3 career advancement opportunities for health 

4 workers, as well as training on core com5 petencies. 

6 ‘‘(C) The entity has established work prac7 tices and manageable caseloads that allow 

8 health workers to provide tailored, holistic, per9 son-centered support. 

10 ‘‘(D) The entity ensures— 

11 ‘‘(i) the safety of health workers, in 

12 accordance with applicable fair labor laws; 

13 ‘‘(ii) the supervision, coaching, and 

14 evaluation of health workers, through the 

15 use of evidence-informed process and out16 come indicators developed in consultation 

17 with community health workers, 

18 promotoras, and community health rep19 resentatives (as such terms are defined in 

20 section 1903(cc)(4)); and 

21 ‘‘(iii) leadership and engagement of 

22 health workers in organization- and pro23 gram-level decision making, including deci24 sion making related to the improvement of 

25 processes and outcomes.’’. 


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1 (3) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

2 of the Social Security Act (42 U.S.C. 1395l(a)(1)) 

3 is amended— 

4 (A) by striking ‘‘and’’ before ‘‘(HH)’’; and 

5 (B) by inserting before the semicolon: ‘‘, 

6 and (II) with respect to community health serv7 ices under section 1861(s)(2)(KK), the amounts 

8 paid shall be 100 percent of the lesser of the 

9 actual charge for the services or the amount de10 termined under a fee schedule established by 

11 the Secretary for such services’’. 

12 (4) WAIVER OF APPLICATION OF DEDUCT13 IBLE.—The first sentence of section 1833(b) of the 

14 Social Security Act (42 U.S.C. 1395l(b)) is amend15 ed— 

16 (A) by striking ‘‘, and (13)’’ and inserting 

17 ‘‘(13)’’; and 

18 (B) by striking ‘‘1861(n)..’’ and inserting 

19 ‘‘1861(n), and (14) such deductible shall not 

20 apply with respect to community health services 

21 (as defined in section 1861(nnn)(1)).’’. 


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1 SEC. 3. STATE MEDICAID OPTION TO SUPPORT COMMUNITY 

2 HEALTH WORKFORCE FOR SUSTAINABLE 

3 COMMUNITY HEALTH. 

4 Section 1903 of the Social Security Act (42 U.S.C. 

5 1396b) is amended by adding at the end the following new 

6 subsection: 

7 ‘‘(cc) COMMUNITY HEALTH WORKFORCE SUP8 PORT.— 

9 ‘‘(1) IN GENERAL.—Notwithstanding section 

10 1902(a)(1) (relating to statewideness), section 

11 1902(a)(10)(B) (relating to comparability), and any 

12 other provision of this title that the Secretary deter13 mines is necessary to waive in order to implement 

14 this subsection, beginning January 1, 2025, a State, 

15 at its option as a State plan amendment, may pro16 vide for medical assistance for preventive services 

17 and services to address the social determinants of 

18 health furnished by a community health worker, 

19 promotora, or community health representative. 

20 ‘‘(2) GUIDANCE.—The Secretary shall issue 

21 guidance on the components that are necessary for 

22 a State plan amendment to receive approval under 

23 this subsection, including: 

24 ‘‘(A) Plans to recruit community health 

25 agencies for the provision of preventive services 

26 and services to address the social determinants 


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1 of health that are furnished by a community 

2 health worker, promotora, or community health 

3 representative. 

4 ‘‘(B) Plans to make medical assistance 

5 available for each category of preventive serv6 ices and services to address the social deter7 minants of health. 

8 ‘‘(C) Plans to ensure that the preventive 

9 services furnished by community health work10 ers, promotoras, or community health rep11 resentatives under the amendment will respond 

12 to public health emergencies. 

13 ‘‘(D) Plans to minimize barriers to com14 munity health worker, promotora, or commu15 nity health representative program participation 

16 in the State plan, such as by providing guid17 ance and technical assistance on requirements 

18 for participation. 

19 ‘‘(E) Plans to coordinate with and build 

20 the capacity of community health worker net21 works within the state or region. 

22 ‘‘(F) Plans to address barriers to partici23 pation experienced by community health agen24 cies that do not bill insurance for other services, 

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1 zations, academic institutions, faith-based orga2 nizations, tribal organizations, or other organi3 zations that employ community health workers, 

4 promotoras, or community health representa5 tives, including by implementing a mechanism 

6 to reimburse such community health agencies 

7 for preventive services and services to address 

8 the social determinants of health. 

9 ‘‘(3) INCREASED FMAP.— 

10 ‘‘(A) IN GENERAL.—Notwithstanding sec11 tion 1905(b), for calendar quarters beginning 

12 on or after January 1, 2025, the Federal med13 ical assistance percentage determined under 

14 such section for a State shall be increased by 

15 6 percentage points with respect to amounts ex16 pended by the State for medical assistance for 

17 preventive services and services to address the 

18 social determinants of health furnished by a 

19 community health worker, promotora, or com20 munity health representative that is provided in 

21 accordance with a State plan amendment ap22 proved under this subsection or otherwise pro23 vided in accordance with the guidance issued 

24 under paragraph (2). 


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1 ‘‘(B) EXCLUSION OF AMOUNTS ATTRIB2 UTABLE TO INCREASED FMAP FROM TERRI3 TORIAL CAPS.—With respect to payments made 

4 to a territory for expenditures for medical as5 sistance described in subparagraph (A), the 

6 portion of such payment that exceeds the 

7 amount that would have been paid without re8 gard to the increase in the Federal medical as9 sistance percentage under such subparagraph 

10 shall not be taken into account for purposes of 

11 applying payment limits under subsections (f) 

12 and (g) of section 1108. 

13 ‘‘(4) DEFINITIONS.— In this subsection: 

14 ‘‘(A) COMMUNITY HEALTH AGENCY.—The 

15 term ‘community health agency’ has the mean16 ing given that term in section 1861(nnn). 

17 ‘‘(B) COMMUNITY HEALTH REPRESENTA18 TIVE.—The term ‘community health representa19 tive’ means a frontline health worker who is a 

20 trusted member of a tribal community with a 

21 close understanding of the community, lan22 guage, and traditions that enables the worker 

23 to serve as a liaison between health and social 

24 services and the community, facilitate access to 


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1 services, and improve the quality and cultural 

2 competence of service delivery. 

3 ‘‘(C) COMMUNITY HEALTH WORKER.—The 

4 term ‘community health worker’ means a front5 line health worker who is a trusted member of 

6 the community in which the worker serves or 

7 who has an unusually close understanding of 

8 the community served that enables the worker 

9 to build trusted relationships, serve as a liaison 

10 between health and social services and the com11 munity, facilitate access to services, and im12 prove the quality and cultural competence of 

13 service delivery. 

14 ‘‘(D) COMMUNITY HEALTH WORKER NET15 WORK.—The term ‘community health worker 

16 network’ means a statewide, regional, or local 

17 association or coalition with leadership and 

18 membership that is composed of at least 50 

19 percent community health workers, promotoras, 

20 or community health representatives and whose 

21 activities include training, workforce develop22 ment, mentoring, and other initiatives to sup23 port community health worker, promotora, and 

24 community health representative programs. 


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1 ‘‘(E) PREVENTIVE SERVICES.—The term 

2 ‘preventive services’ means services described in 

3 clause (i) of section 1861(nnn)(1)(B). 

4 ‘‘(F) PROMOTORA.—The term ‘promotora’ 

5 means a trusted frontline worker who primarily 

6 works in Spanish-speaking communities and 

7 who shares lived experiences, language, and cul8 ture with the populations served that enables 

9 the worker to improve individual, family and 

10 community health outcomes by serving as a liai11 son between health and social services and the 

12 community, facilitating access to services, and 

13 improving the quality and cultural competence 

14 of service delivery. 

15 ‘‘(G) SERVICES TO ADDRESS THE SOCIAL

16 DETERMINANTS OF HEALTH.—The term ‘serv17 ices to address the social determinants of 

18 health’ means services described in clause (ii) of 

19 section 1861(nnn)(1)(B).’’. 

Æ 


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